Ureteral Stump Research Articles

Minimally invasive surgery for the treatment of ureteral stump syndrome.

Objective:The aim was to highlight the advantages and the feasibility of treating ureteral stump syndrome (USS) by different minimally invasive procedures.Materials and Methods:Four patients with USS who were treated by different minimally invasive surgery approaches depending on their presentation and findings on radiologic investigations.Results:Three patients had complete resolution of their symptoms, whereas the fourth patient had persistence of urinary tract infection.Conclusion:Minimally invasive surgery is a valid treatment option for patients with USS with possible less morbidity than conventional open surgical excision.

Split-cuff nipple technique of ureteral reimplantation in children with thick-walled bladders due to posterior urethral valves.

To describe a novel technique of ureteral reimplantation in patients with thick-walled bladders, which addresses the technical challenges and high failure rates seen in this population. From 1997 to 2012, 45 megaureters were reimplanted in 26 children aged 2-11 years. Key surgical modifications included ureteral trough creation within the detrusor, formation of a distal ureteral split-cuff nipple, reliance on transureteroureterostomy (TUU) when the bladder would not support the reimplantation of 2 ureters, performance of psoas vesicopexy, and judicious utilization of ureteral stump augmentation in patients undergoing TUU. Follow-up ranged from 1 to 12 years. Seven patients underwent unilateral and 4 underwent bilateral ureteral reimplantation; TUU was performed in 15. Psoas vesicopexy was performed in 22 patients. Voiding cystourethrography showed no reflux in all children who underwent vesicopexy. Reflux resolved in 6 of 8 bilaterally reimplanted ureters; 2 of 8 had improved reflux that later resolved with Deflux injection. No ureters obstructed. Hydronephrosis improved in 32 of 45 renal units and remained stable in 13. Seven patients continue to develop bacteriuria. Five have developed renal failure. In our experience, a long ureteral trough combined with a split-cuff nipple technique for reimplanting megaureters into thick-walled bladders yields improved results over conventional submucosal tunneling, effectively eliminating or improving reflux and preventing obstruction. TUU and psoas vesicopexy proved useful adjuncts in creating adequate intravesical trough length. The risk for continued bacteriuria and renal failure due to limited renal reserve, however, remain notable in this group.

Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract.

We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.

Laparoscopic Ureteroureterostomy and Transvaginal Ureterectomy for Complete Duplicated Ureters

To report our experience and the feasibility of transvaginal ureterectomy for refluxing ectopic ureter after laparoscopic ureteroureterostomy. Ureteroureterostomy is a treatment modality for preserving upper pole kidney function in patients with complete duplicated ureters (CDU). Because of the residual ureteral stump, however, the development of urinary tract infection may be a concern. We retrospectively reviewed the data of patients with a diagnosis of CDU who underwent surgery between 2007 and 2012. Six female patients with CDU were identified. Of these six patients, four underwent transvaginal ureterectomy after laparoscopic ureteroureterostomy. No patients experienced intraoperative complications. Total mean surgical time in four patients was 250 minutes. Mean laparoscopic ureteroureterostomy time took 180 minutes, and ureterectomy by vaginal incision took 40 minutes, respectively. Mean blood loss was 150 mL. The first patient experienced postoperative complications of mild urine leak and ureteral stricture in the anastomosed site. Our experience suggests that transvaginal ureterectomy after laparoscopic ureteroureterostomy is a minimally invasive modality that may be a technically feasible and effective option for patients who have CDU with refluxing ectopic ureters.

English

Ureterocutaneous fistula could be Urological, Gynecological or due to malignancy and trauma. However ureterocutaneous fistula due to persistent stone in ureteral stump long time after nephrectomy is rare. We report this case and its management due to its rarity. INTRODUCTION: An ureterocutaneous fistula is defined as abnormal communication between the urinary tract and skin. It may arise from the urinary tract anywhere from kidney to the urethra. Ureterocutaneous fistula may occur as a result of chronic infection especially in the setting of calculus disease. 1

V3-04 ROBOTIC-ASSISTED LAPAROSCOPIC HEMINEPHRECTOMY: THE RETROGRADE TECHNIQUE

You have accessJournal of UrologyPediatrics1 Apr 2014V3-04 ROBOTIC-ASSISTED LAPAROSCOPIC HEMINEPHRECTOMY: THE RETROGRADE TECHNIQUE Rodrigo Ledezma, Rena Malik, Pankaj Dangle, and Mohan Gundeti Rodrigo LedezmaRodrigo Ledezma More articles by this author , Rena MalikRena Malik More articles by this author , Pankaj DanglePankaj Dangle More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1305AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We illustrate our “retrograde technique” for robotic-assisted laparoscopic heminephrectomy (RAL-HN). We also describe the clinical outcomes using this approach in the pediatric population with duplicated systems (DS). METHODS A 5 year-old girl with history of right DS with a nonfunctioning upper moiety and hydroureter. On follow-up, she presented with urinary incontinence and febrile UTI. At this point, a recommendation for HN was made. A retrograde technique was used to help identify vasculature to the diseased moiety. The diseased moiety ureter is separated from the healthy moiety and transected, it is then passed posterior to the renal hilum cranially to allow better visualization of the vascular anatomy. RESULTS The surgery was uncomplicated. The patient was discharged on postoperative day 3 after an uneventful hospital stay. At one month of follow-up, she is dry and doing well. Ultrasound revealed a healthy lower moiety. We have completed thirteen transperitoneal RAL-HN between 2009 and 2013. Mean age at surgery was 24.7 months and mean operative time was 144 minutes, with an estimated blood loss of 11 cc. No patients required open conversion. Mean hospital stay was 2.1 days (1-3 days) and no major complications were observed. Mean follow up was 13.4 months. One patient required secondary ureterectomy for recurrent urinary tract infection and refluxing ureteral stump. No patients lost their remaining healthy moiety. Change in renal function based on nuclear scan of the duplex kidney ranged from -10.5% to +1% (median 0%). CONCLUSIONS RAL-HN is a safe surgical option for pediatric patients with duplex moieties with appropriate surgical outcomes. The retrograde technique allows easy identification of the upper moiety vessels and transection without traction on the hilum of lower moiety © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e422 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Rodrigo Ledezma More articles by this author Rena Malik More articles by this author Pankaj Dangle More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V3-05 ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN A 2 YEARS OLD CHILDREN WITH RHABDOMYOSARCOMA

INTRODUCTION AND OBJECTIVES: We illustrate our “retrograde technique” for robotic-assisted laparoscopic heminephrectomy (RAL-HN). We also describe the clinical outcomes using this approach in the pediatric population with duplicated systems (DS). METHODS: A 5 year-old girl with history of right DS with a nonfunctioning upper moiety and hydroureter. On follow-up, she presented with urinary incontinence and febrile UTI. At this point, a recommendation for HN was made. A retrograde technique was used to help identify vasculature to the diseasedmoiety. The diseasedmoiety ureter is separated from the healthy moiety and transected, it is then passed posterior to the renal hilum cranially to allow better visualization of the vascular anatomy. RESULTS: The surgery was uncomplicated. The patient was dischargedonpostoperative day 3 after anuneventful hospital stay. At one monthof follow-up, she isdry anddoingwell.Ultrasound revealedahealthy lower moiety. We have completed thirteen transperitoneal RAL-HN between 2009 and 2013. Mean age at surgery was 24.7 months and mean operative time was 144 minutes, with an estimated blood loss of 11 cc. No patients required open conversion. Mean hospital stay was 2.1 days (1-3 days) andnomajor complicationswereobserved.Mean followupwas13.4 months.Onepatient requiredsecondary ureterectomy for recurrent urinary tract infection and refluxing ureteral stump. No patients lost their remaining healthy moiety. Change in renal function based on nuclear scan of the duplex kidney ranged from -10.5% to +1% (median 0%). CONCLUSIONS: RAL-HN is a safe surgical option for pediatric patients with duplex moieties with appropriate surgical outcomes. The retrograde technique allows easy identification of the upper moiety vessels and transection without traction on the hilum of lower moiety

V1-12 SURGICAL MANAGEMENT OF MIXED URINARY INCONTINENCE FROM REMNANT ECTOPIC URETERAL STUMPS

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-12 SURGICAL MANAGEMENT OF MIXED URINARY INCONTINENCE FROM REMNANT ECTOPIC URETERAL STUMPS Adam Kaplan, Martin Hofmann, Zhamshid Okhunov, and Gamal Ghoniem Adam KaplanAdam Kaplan More articles by this author , Martin HofmannMartin Hofmann More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , and Gamal GhoniemGamal Ghoniem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.606AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ectopic ureteral drainage distal to the bladder neck is a well-established cause of urinary incontinence. Mixed incontinence that persists after bilateral reimplantation, however, may be due to drainage from the remaining ureteral stumps stimulating a urethrovesical reflex. METHODS A 24-year-old female with mixed urinary incontinence and recurrent urinary tract infections was found to have bilateral ectopic ureters inserting into the mid-urethra. Her incontinence persisted after injection of macroplastique urethral bulking agent and bilateral ureteral reimplantation. Voiding cystometrogram and Fluoro-urodynamics confirmed urine reflux into the distal ureteral stumps and subsequent spontaneous drainage, which was responsible for her incontinence symptoms. We sought to treat her incontinence with excision of the ectopic ureter stumps, bladder neck reconstruction and placement of an autologous rectus fascia urethral sling. RESULTS Transvaginal exposure of the urethra was achieved. Cystoscopically, 5-French ureteral catheters were placed directly into the ectopic ureteral stumps. The stumps were then visualized and excised and the remaining defects in the urethra and bladder neck were closed primarily. An autologous rectus fascia pubovaginal sling was harvested and secured. Postoperatively, the patient had a global assessment of improvement of 80% and regained continence. CONCLUSIONS Residual ectopic ureteral stumps after implantation can be a rare cause of persistent urinary incontinence. Successful treatment can be achieved with excision of the residual ureteral stumps, reconstruction of the bladder neck and placement of an autologous rectus fascia urethral sling. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e295 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Adam Kaplan More articles by this author Martin Hofmann More articles by this author Zhamshid Okhunov More articles by this author Gamal Ghoniem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteroarterial fistula from ureteral stump: a challenging case.

Ureteroarterial fistula (UAF) is a relatively rare condition with about 150 cases reported in the literature. Since it is a potentially life-threatening condition, a prompt diagnosis and treatment are crucial. We present here a rare, challenging case of UAF diagnosed after left nephrectomy, thus involving the ureteral stump. The difficult diagnosis and treatment by contemporary use of endovascular stent placement and ureteral occlusion by mean of metallic coils and Onyx injection are discussed.

Solitary Metachronous Metastasis of Renal Cell Carcinoma to the Ureter

Renal cell carcinoma is well known for its varied presentation and its potential of metastasizing to virtually any organs. Metastasis to the ureter or bladder is extremely rare. To date only 52 cases of metastatic renal cell carcinoma to ureter have been reported. We report a case of metachronous solitary metastasis of renal cell carcinoma to the ipsilateral ureteric stump one year after radical nephrectomy of the primary tumour. Completion ureterectomy and partial cystectomy was performed and pathology confirmed metastatic renal cell carcinoma. Six months later the patient was found to have bladder recurrence again. Contrast computed tomography scan of abdomen showed multiple liver metastases. The disease progressed despite use of target therapy. He finally succumbed 29 months after the initial nephrectomy.

Urothelial carcinoma in a remnant ureter after a radical nephrectomy for renal cell carcinoma: A case report

Urothelial carcinoma of a ureteral stump after a radical nephrectomy for renal cell carcinoma is rare. We present the case of a 76-year-old man with painless gross hematuria. The patient had undergone a right nephrectomy for renal cell carcinoma 30 months previously. Cystoscopy showed a blood clot in the right ureteral orifice, and ureteroscopy revealed a papillary mass in the right ureter. The patient underwent a right ureterectomy and bladder cuff resection. The pathology examination showed a high-grade urothelial carcinoma. However, a superficial bladder tumor was discovered postoperatively, and a transurethral resection of the bladder tumor was performed. At 8 months postoperatively, the patient was alive with no evidence of recurrence. A ureteral stump evaluation must be performed when painless hematuria is noted in patients after a nephrectomy.

Ureterocolonic fistula formation 12 years after a nephrectomy for renal tuberculosis with a staghorn stone

A postoperative ureterocolonic fistula is rare; only two cases have been reported in the past 38 years in the English medical literature. A 77-year-old female with left renal tuberculosis and staghorn stone received a nephrectomy and a 9-month course of antituberculous therapy. Twelve years later, she experienced repeated urinary tract infection and associated pneumaturia despite medical treatment. Cystoscopy revealed yellowish debris in the bladder, and a computed tomographic examination showed an air bubble in the bladder and a highly suspected fistula between the left ureteral stump and sigmoid colon. After a fistulectomy, she completely recovered, and follow-up urinalysis yielded normal results. This case report highlights this rare condition of urinary tract infection secondary to fistula formation from the ureteral stump even 12 years postoperatively. In addition, we compare different imaging techniques and hypothesize that a nephroureterectomy may be indicated for an inflammatory nonfunctioning kidney containing a staghorn stone.

Laparoscopic pelvic lymph node dissection system based on preoperative primary tumour stage (T stage) by computed tomography in urothelial bladder cancer: results of a single‐institution prospective study

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Bladder cancer (BC) is a public health problem throughout the world, and now radical cystectomy (RC) has been introduced as a standard treatment for BC invading muscle and some BCs not invading muscle. Pelvic lymph node dissection (PLND) is considered an integral part of RC for its prognostic and therapeutic significance, but the extent of the PLND has not been precisely defined. Computed tomography is considered one of the most preferable methods to assess the BC stage preoperatively because of its high sensitivity and specificity. However, there are few articles referring to CT as an aid in deciding the extent of lymphadenectomy during RC. In the present study, we prospectively studied the clinical value of preoperative CT staging of primary tumours in deciding the extent of PLND during laparoscopic RC in the management of BC. The preliminary findings suggested that all patients with higher preoperative CT stage should be given super-extended PLND during RC. For those with lower CT stage, careful and thorough clearance of all lymphatic and adipose tissues within the true pelvis could be more helpful than super-extended PLND. To study prospectively the clinical value of preoperative spiral computed tomography (CT) staging of primary tumours in deciding the extent of pelvic lymph node dissection (PLND) during laparoscopic radical cystectomy (RC) in the management of bladder cancer (BC). Between January 2010 and December 2011, a total of 63 patients with urothelial BC received laparoscopic RC, super-extended PLND and ileac conduit. The super-extended PLND removed all lymphatic tissues in the boundaries at the level of the inferior mesenteric origin from the aorta (cephalad), the pelvic floor (distally), the genitofemoral nerve (laterally) and the sacral promontory (posteriorly). All of the operations were performed by one experienced surgeon, and all harvested lymph nodes were submitted separately. CT was used to evaluate the preoperative CT stage (CTx) of each primary bladder tumour. All patients were divided into five categories according to their CTx stages: three at CT1, seven at CT2a, 38 at CT2b, seven at CT3b, and eight at CT4a. All 63 procedures were completed successfully without any conversion to open surgery. The mean estimated blood loss was 450 mL, and 14 patients (22.2%) had postoperative lymphatic leakage. Each case was pathologically confirmed as transitional cell carcinoma with negative margins at the urethral and ureteric stumps. None of the patients with a low CTx stage (CT1-CT2a) had positive lymph nodes above the level of the common iliac artery bifurcation. There was no jump lymph node metastasis, and no positive lymph node was detected above the level of aortic bifurcation in all cases. Based on the preoperative CT staging, urological surgeons can determine the boundaries of PLND to reduce intraoperative injury and postoperative complications in patients with BC, especially those at the lower CTx stages (CT1 and CT2a).

Case Report: Primary Urothelial Carcinoma of Ureteral Stump Following Radical Nephrectomy for Renal Cell Carcinoma

PUC is common in the urinary tract. It may occur in the urinary bladder and the collecting system of the upper urinary tract, such as the renal pelvis and ureter. However, PUC of ureteral stump after a nephrectomy is rare, and it’s even rarer in patients undergoing a radical nephrectomy for RCC. We describe a female patient with painless gross hematuria that was secondary to PUC of ureteral stump after a radical nephrectomy for RCC diagnosed 6 years ago. We discuss the etiology, diagnosis and treatment for PUC of ureteral stump following radical nephrectomy for RCC.

Ectopic insertion of the ureter into the seminal vesicle

We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly. The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incontinence, leading to the diagnosis, while in males it is present with infection. Ectopic ureter is defined as abnormal insertion of the ureter, occurring in the posterior urethra in approximately 50% of cases in males. Other sites include the seminal vesicle (approximately one-third), vas deferens, bladder neck, prostate and epididymis, while the urethra and vagina are commonly affected in females. Management is usually addressed to the upper tract only; if there is incontinence it requires removal of the ureteric stump. Our case was initially diagnosed by magnetic resonance imaging and the diagnosis confirmed by computed tomography (CT) guided seminal vesiculography as transrectal guidance for seminal vesiculography was refused by the patient. CT guided seminal vesiculography is less painful and more tolerable than the transrectal route.

Laparascopic-assisted nephroureterectomy for shaped urolithiasis and xanthogranulomatous pyelonephritis: Case report and review of literature

We report a case of xanthogranulomatous pyelonephritis (XGP) complicated by shaped urolithiasis, severe hydroureteronephrosis and kidney exclusion treated by laparoscopic-assisted nephroureterectomy. A 9 year-old boy was referred to us for recurrent episodes of urinary tract infection, abdominal pain and severe hydronephrosis. Abdominal CT and a Tc-99m MAG3 scan showed a non-functioning obstructed kidney with shaped urolithiasis of the distal ureter. XGP was suspected, and nephroureterectomy was performed by laparoscopic distal ureterectomy and open extraperitoneal nephrectomy. This technique avoided the need for a more extended nephrectomy incision or even a second iliac incision. It also ensured complete excision of the distal ureter with minimal risk of developing the ureteral stump syndrome, which sometimes follows nephroureterectomy. We believe that laparoscopic-assisted nephroureterectomy may be a suitable technique in those cases of difficult nephrectomy where a ureteral stump syndrome is likely to develop.

Editorial Comment to Male infant with a single‐system ectopic ureter that required the removal of the ureteral stump after nephrectomy

Editorial Comment to Male infant with a single‐system ectopic ureter that required the removal of the ureteral stump after nephrectomy

Male infant with a single‐system ectopic ureter that required the removal of the ureteral stump after nephrectomy

The necessity of removing ureteral stumps after upper tract surgery for ectopic ureters has been debated, because the procedure can be difficult to carry out and might cause injury to bladder continence mechanisms. Fortunately, ureteral stumps rarely cause problems. We herein report the case of a single-system ectopic ureter that required the removal of the ureteral stump after nephrectomy. In our case, reflux into the ectopic ureter adversely affected the dilation of the ureteral stump. Although urine might flow through an ectopic opening during the voiding phase as a result of high pressure, residual urine might be unable to flow during the storage phase because of low pressure in the ureteral stump. The removal of ureteral stumps might be required in patients with reflux into ectopic ureters. When surgical intervention is necessary for patients with megaureters, cystourethroscopy should be carried out to more accurately clarify the anatomy of the lower urinary tract.

Unilateral Urological Double Cancer after Kidney Transplantation

In organ transplant patients, the high incidence of malignancy is well known. Here we experienced a simultaneous double cancer may occur after renal transplantation in the urinary tract. The patient was a 64-year-old woman. Diagnosis of renal failure undergoing Toxemia of pregnancy in 1971. Be introduced as end stage renal disease undergoing hemodialysis since 1978. Living donor kidney transplant performed in March 1980(The donor was her father). Renal transplantation immunosuppressive therapy was introduced azathioprine · methylprednisolone. Current maintenance immunosuppressive therapy is Mizoribine · methylprednisolone. Renal function after transplantation (2.3 to value 2.5 Serum creatinine) had remained in good condition. Admitted in January 2011, gross hematuria thereafter. No abnormal urine cytology tests, especially since no observation was also asymptomatic. Again showed gross hematuria in May 2011. Subject to the inspection report positive urine cytology again. Admitted to a space-occupying lesion in the left renal pelvis examination CT. Resection underwent left nephroureterectomy, July 29, 2011 left kidney tumor was diagnosed. Ureter were removed at the intersection of the left iliac artery. Pathological diagnosis of renal tissue excised Clear cell carcinoma, pT3a, G1> G2, Fuhrman grade 1, was INFa. Pathological diagnosis of the ipsilateral ureter was excised similarly invasive urothelial carcinoma of It ureter, G2, INFb, were pT1. Ureteral stump pathologic findings were observed in excised malignancy. Postoperative renal graft function is stable even without any particular change. We had have to be continued careful watching in our outpatient clinic. We report an example of urinary tract cancers occurring simultaneously in one side to the urinary tract 21 years after renal transplantation.

Factors Associated with Complications of the Ureteral Stump After Proximal Ureteroureterostomy

Ureteroureterostomy is a treatment modality for managing an ectopic ureterocele or ectopic ureter and preserving upper pole kidney function. However, the development of urinary tract infection at the residual ureteral stump is a concern. We analyzed factors affecting the development of urinary tract infection at the residual ureteral stump after proximal ureteroureterostomy. Between January 2002 and December 2009 proximal ureteroureterostomy was performed in 80 patients with ectopic ureterocele or ectopic ureter associated with a duplex system. Excluding 6 patients who did not meet the study inclusion criteria, we investigated age at operation, diameter of the upper pole ureter on ultrasonography, differential renal function and the presence of vesicoureteral reflux in 74 patients. Risk factors for residual ureteral stump infection and decreased differential renal function were analyzed. During a median followup of 5.0 years an additional operation was required in 9 patients (12.2%) due to urinary tract infection at the residual ureteral stump a median of 2.4 years after initial proximal ureteroureterostomy. The preoperative maximal diameter of the upper pole ureter was significantly greater in patients with infection complications. The postoperative maximal diameter of the upper pole ureter was also significantly greater on postoperative ultrasonography performed a median 43.0 days after the operation. Median preoperative and postoperative differential renal function was 47.8% and 47.0%, respectively. No preoperative factors were significantly related to the decrease in differential renal function. Proximal ureteroureterostomy is a safe treatment for ectopic ureterocele or ectopic ureter with a low postoperative complication rate. Upper pole ureter diameter was correlated with the development of a urinary tract infection at the residual ureteral stump.